HIT 130-01
Jan Geisler is the HIM director at Hillside Medical Center. The administration at Hillside has just approved the budget, which includes a new electronic health record. They assign Jan as the project manager and give her the task of reviewing and selecting the company (vendor) with the EHR that best suits the hospital's needs. Jan immediately thinks of her college roommate Ana. Ana also majored in HIM and now works for a large EHR vendor in California. Jan sends a quick email to Ana to catch up and asks about her company's EHR system. Ana responds immediately with updated pictures of her family and some general information about the EHR her company sells. Ana offers for her company to fly Jan to California so she can see the system and have a live demonstration. As an added bonus, Ana cannot wait to see her friend, take her to dinner, and catch up. Jan goes to California and enjoys her time with Ana, but she is a little disappointed with the EHR system. She just doesn't think it will meet the needs of her hospital. Jan has a meeting with the chief information officer today and is expected to present her recommendations. She feels obligated to recommend Ana's company but she also has major concerns about their product. What ethical issues can be found in Jan's investigation of an EHRs? Was it a conflict of interest for Jan to do business with her personal friend Ana? Using the ethical decision making model found in this chapter, analyze the scenario and recommend a decision.
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A well known pop star, Brittany Spears was admitted to Los Angeles' Cedars-Sinai Medical Center for psychiatric evaluation as part of a child-custody dispute with ex-husband Kevin Federline, who temporarily had sole legal and physical custody of the couple's children. Dr. Phil McGraw, a well-known talk show host and friend of the family visited Spears in the hospital on January 7th without Spears consent. McGraw subsequently released a statement were he said his: "meeting with Brittany and some of her family members this morning in her room at Cedars leaves me convinced more than ever that she is in dire need of both medical and psychological intervention. She was released moments before my arrival and was packing when I entered the room. We visited for about an hour before I walked with her to her car. I am very concerned for her." (Harris 2008)
1. Hospital directory—potential HIPAA violation, how did he know what room to visit? Did Dr. Phil have Brittany's authorization to speak about her care? This is an ethical issue on the part of Dr. Phil. 2. This situation can be looked at in two ways. If Dr. Phil was acting in the capacity of her doctor, then yes, he may have had the right to visit her, but not to discuss what went on between the doctor and Brittany. If he was not her doctor, then he did not have a right to visit Brittany, nor to discuss what took place during their meeting in terms of her health. Source: Harris, C. 2008 (Jan.7). Dr. Phil defends visit to Brittany Spears as a favor to family. Viacom: MTV News. http://www.mtv.com/news/articles/1579099/20080107/spears_Brittany.jhtml
Jessica is the director of Health Information and Technology Services at General Hospital. At this facility, patient records are hybrid. The hospital was named as a defendant in a medical malpractice lawsuit by a former patient (i.e., plaintiff). The trial is scheduled during the next week. During the discovery process, the plaintiff's health records and an incident report relative to the plaintiff's hospital stay were obtained by the plaintiff's attorney. The plaintiff's attorney has made it clear that she intends to have the health records and the incident report admitted into evidence and, further, that metadata associated with the electronic portions of the plaintiff's records will be sought. Questions: What is the likelihood of the incident report being admitted into evidence? On what legal theory do you rely to support your answer? How should Jessica prepare for the trial
1. Incident reports are less likely to be admitted into evidence than health records because they may not meet all the elements of the business records exception (for example, created at or near the time of the matter recorded). As a related matter, state law varies on the discoverability of incident reports. Students should be aware of the laws in their own state. 2. Jessica should inform the hospital attorney of the request and have the hospital attorney talk to the opposing attorney prior to the trial. Jessica should insist that the hospital attorney be present when she is questioned in court about the record so that he/she may protect the record.
Provide this edited transcript of the March 16, 2008, interview by 60 Minutes host Steve Kroft with Dennis Quaid. Follow-up to this story is provided titled "Medical Errors Happen 'Too Often' " Dennis Quaid Recounts Twins' Drug Ordeal http://www.cbsnews.com/stories/2010/04/12/earlyshow/health/main6387793.shtml March 16, 2008 (CBS) Chances are you probably know someone who has died, or nearly died, because of medical mistakes in a hospital. It's much more common than most people realize, and if it can happen to the children of movie star, at one of the finest hospitals in the country, it can happen to anyone. Dennis Quaid has starred in more than 50 films, but nothing prepared him for the drama and the near tragedy that unfolded last November at Cedars-Sinai hospital in Los Angeles, when his infant twins were given massive overdoses of a blood thinner that nearly killed them.....the nurses had discovered that both twins were in serious danger. They were supposed to have been given a pediatric blood thinner called Hep-lock to flush out their IV lines and prevent blood clots. But instead, they had been given two doses of Heparin, the adult version of the drug, which is 1,000 times stronger. "We all have this inherent thing that we trust doctors and nurses, that they know what they're doing. But this mistake occurred right under our noses, that the nurse didn't bother to look at the dosage on the bottle," Dennis Quaid tells Kroft. "It was ten units that our kids are supposed to get. They got 10,000. And what it did is, it basically turned their blood to the consistency of water, where they had a complete inability to clot. And they were basically bleeding out at that point." "There was blood oozing out of little blood draws on their feet, and things like that, you know, through band-aids," he adds. Quaid says that's what first alerted the nurse that there was a problem. But the hospital never called the Quaids and they didn't find out that anything was wrong until the next day when they showed up at the hospital early the next morning and went to the twins' room. "We were met at the door by our pediatrician, the nurse - head nurse that was on duty," Dennis Quaid recalls. "Risk management," his wife adds. "Risk management, which is basically the liability division of a hospital, which is lawyers," he explains. .."They weren't just given one massive overdose, they were given two massive overdoses?" Kroft asks. "Two massive overdoses, a thousand times what they should have over an eight-hour period that we know of," Quaid says. And to make matters worse the same avoidable mistake had occurred a year earlier at Methodist Hospital in Indianapolis. Six infants were given multiple adult doses of Heparin instead of the pediatric version; three of the infants survived, three did not. Asked when he found out about the Indianapolis incident, Quaid says, "In the morning when I had gone in, a pediatrician told me about it." "He said, 'This has happened before'?" Kroft asks. "Yeah. He had told me about that three babies died. And it sent a chill down my spine," Quaid remembers. The Quaids say the crisis went on for 41 hours, as doctors and nurses administered an antidote to Heparin, which helps the blood coagulate. Slowly the twins began to stabilize, and after 12 long days in the hospital, they were allowed to come home. ... But the experiences changed Dennis Quaid. He's spent much of the past four months trying to dissect what happened and figuring out ways to draw attention to what is one of the leading causes of death in America - preventable human, medical error. "These mistakes that occurred to us are not unique. And they're not unique even to Cedars. They happen in every hospital, in every state in this country. And 100,000 people, that I've come to find out, there's 100,000 people a year are killed every year in hospitals by a medical mistakes," he says. Because the deaths occur one at a time, all over the country over an extended time period, Quaid says the issue has slipped under the public's radar. "It's bigger than AIDS. It's bigger than breast cancer. It's bigger than automobile accidents. And, yet, no one seems to be really be aware of the problem," he says. The causes range from misdiagnosis to surgical errors to medication mistakes like the accidental Heparin overdose that that nearly killed the Quaid twins, an occurrence that's not all that unusual, according to Diane Cousins. She's the vice president of U.S. Pharmacopeia, a non-profit public health group that maintains one of the largest databases on medication errors. "What we see with Heparin is that it is almost always in the list of top ten drugs that are reported for medication errors, and almost always in the top ten that are harmful," Cousins tells Kroft. "What is it about Heparin that there's so many mistakes?" Kroft asks. "Well, Heparin is very commonly used in the hospital. And the number of opportunities for error are very high," she explains. But Cousins says another contributing factor with Heparin is labeling that can easily lead to mistakes. The 10-unit pediatric dose and the 10,000-unit adult dose come in vials of identical size and shape and in different shades of blue that can easily be confused, if not seen in reference to each other. And they are not the only drugs with that problem. Asked to give some examples, Cousins, showing two medications, tells Kroft, "In this case, we have a solution of Lidocaine, which is an anesthetic often used to swab a child's throat or mouth for mouth pain. Here, you have lithium oral solution used for manic depression." "Lithium is not something you'd wanna give a child. Absolutely not," she says. The two small vials Cousins used as an example both have blue caps and cluttered labels, but one contains a hormone and the other a children's antibiotic. "If you're at arms' length, it's hard enough to read these labels because of their type size," Cousins says "And I'd need my reading glasses," Kroft remarks. Baxter International, which manufactures the Heparin given to the Quaid twins, was fully aware that there had been fatal mistakes that may have been caused by confusion over its labeling. When the three infants in Indianapolis died after receiving an adult dose, Baxter issued a nationwide safety alert and last October, began shipping Heparin with a redesigned, peel-off label to end the confusion. What it didn't do was recall the old stock that was sitting in hospitals all over the country, including Cedars-Sinai in Los Angeles. "And as a result, our kids were given an old stock which was basically the same packaging and form that the kids in Indiana had gotten. Now, they recall toasters. They recall trucks. They recall dog food that came from China last year. But they don't recall medicine that kills people if you give it in the wrong dosage," Dennis Quaid tells Kroft. The Quaids believe that Baxter was the first link in a series of events that led to the overdosing of their infants and they're suing the company for negligence on behalf of their children. Debra Bello, a senior director at Baxter, says there was nothing wrong with their product, and it wasn't their fault. "One of the most important components of medication administration is to read the label, and not rely on color, shape or size," she says. "You sent out this warning which mentions not to rely on the color but to read the label...and you redesigned it," Kroft remarks. "When you designed this new vial, why didn't you recall the old ones?" "The, these vials are given over 100,000 times each day, safely, effectively. But nothing replaces reading that drug before you administer it," Bello says. Asked if the company didn't think it was necessary to recall those drugs, Bello says, "No, because the product was safe and effective and the errors, as the hospital was acknowledged, were preventable and due to failures in their system." That's not in dispute. A California Department of Health Services investigation found that there had been at least three critical systems failures at Cedars-Sinai hospital, in which pharmacy technicians and nurses neglected to check the drugs they were distributing and administering. Thomas Priselac, the president and CEO of Cedars-Sinai, didn't dispute the findings. "This was a preventable error. It was the result of human error," Priselac says. "You're talking about a situation here where you had three different people make a mistake," Kroft points out. "Yes," Priselac acknowledges. "What coulda been a fatal mistake. You got the people who put the wrong drug in the drawer. You got the people who picked it up and brought it to the floor. And you got the nurses that looked at it - or didn't look at it - and put it in the IV line. Three people," Kroft says. " Any time an error occurs, almost by definition, the unusual or the unexpected is what's occurred. And certainly in this particular case, that's what occurred," Priselac says. "We have to make sure we have backup systems that pick up things when human error may occur to prevent that error from manifesting itself." "But you had backup systems. You had three people," Kroft remarks. "Right," Priselac replies. "You haven't sued the hospital even though they're - all sorts of reports have been done and the hospital has acknowledged serious mistakes," Kroft asks Dennis Quaid. "I'd like to see Cedar Sinai take the lead in doing something to change what's going on in what I consider to, in the end, a broken healthcare system in patient medical care," the actor says. Quaid calls it a conspiracy of silence, where doctors protect nurses, nurses protect hospitals, insurance companies protect drug manufacturers. Almost no one, he says, is aggressively trying to find ways to eliminate medical mistakes. So the Quaids are in the final stages of launching a foundation they hope will help remedy a situation that almost destroyed their lives. "You're lucky," Kroft remarks. "Yeah. Extremely lucky. And not a day goes by since then that I don't think a day this one's changed for me, is that I don't take a day for granted anymore 'cause if they hadn't made it, there never woulda been another happy day, really," he says. Since the Quaid incident, Baxter International has voluntarily recalled all supplies of Heparin from the market. It had nothing to do with the Quaids, but with possible contamination at a Chinese manufacturing facility that may have contributed to at least 19 deaths. Questions Discuss the adverse patient occurrences which took place. What preventive measures should have been taken to prevent the adverse patient occurrences?
1. Last November at Cedar Sinai Hospital, the Quaid twins where given adult heparin instead of the pediatric version of the drug which resulted to an overdose of the drug. They were given 10,000 units instead of 10 and as a result the twins were basically bleeding out. This was because of an error made by the nurse who administered the drug because she did not take the time to distinguish between the two different versions of the drug since packaging is almost identical and therefore administered the wrong drug to the twins. The previous year at Methodist hospital in Indianapolis, six infants had been given the adult version of heparin instead o the pediatric version. Three of the infants died as a result. 2. The manufacturer of the drug should have used completely distinguishing labeling and packaging of the drugs to avoid confusion. The people who put the drugs in the drawer should have taken time to distinguish between the two versions of the drug. The nurses who administered the drug ,both at Cedar and Methodist hospitals, should have taken time to read the drug before administering it. Correct Answer: Correct 1. The wrong dose of a medication Heparin was administered to the twin children of Mr. Quaid. This resulted in a major reaction from this medication and almost resulted in the death of the twins. 2. Several things could be done in these cases starting with the labeling of the bottles to make sure there is a distinction from the vials that are for adult administration from those for children. Education of the staff after an event is necessary to ensure that everyone is aware of this incident. Additional results from a root cause analysis could be used to implement other procedural changes.
Mary has recently learned about advance directives in her health information legal class. The information she has obtained, along with her knowledge of the Terri Schiavo case (2005) have convinced her of the benefits of executing an advance directive if she were to become incompetent. Mary is aware that her grandparents feel advance directives are wrong. However, she thinks they might be misinformed about the purpose and function of advance directives. Questions How should Mary go about deciding what type of advance directive is the best for her? 2. Where should she begin to prepare such a document?
1. Mary should investigate both living wills and durable powers of attorney for healthcare decisions. If Mary wants to specify limits on the treatment she wishes to receive, a living will may be more appropriate. She should be aware that a living will may only go into effect in certain situations (for example, a living will may only apply if the individual is incapacitated due to a permanently unconscious or terminal state). State requirements will also specify parameters for executing a living will (for example, who must sign the document; who is not eligible to sign it; the individual must be competent at the time of execution; etc.) If Mary wants to designate someone else to make healthcare decisions on her behalf, a durable power of attorney for healthcare decisions (titles vary by state) may be more appropriate. She will need to designate someone that she trusts to act in accordance with her wishes, and she'll need to discuss those wishes with the individual (the agent). This document is more flexible, but it also relies on someone other than Mary to make the decisions. Given that Mary's grandparents are still alive and she is still pursuing her education, she is probably not old or frail enough to consider a do-not-resuscitate order. Too, a do-not-resuscitate order is limited to hospital admissions 2. Mary may consult an attorney, but templates for both living wills and durable powers of attorney for healthcare decisions are available at healthcare organizations and online through medical associations and bar associations. She must be sure that she follows state requirements for completing the document. These requirements may or may not be present on the templates. She should also be certain that the document she prepares can easily be accessed. It would be desirable to have a copy in her own home; to share it with someone who could access it should the need arise (a likely person is the agent if she executes a durable power of attorney for healthcare decisions); and to have a copy in her medical record at her physician's office and at a hospital where she would most likely receive treatment (keeping in mind that she would not have a medical record there if she hasn't sought treatment in the past).
Dr. Pearson has recently been hired into the Central City Internal Medicine Group as its fifth physician. He has recently completed his residency and is eager to enter private practice. Dr. Pearson is introduced to Meredith and Dawn, two members of the billing staff for the practice. Unbeknownst to Dr. Pearson, Meredith financially assists the practice in several ways. She bills procedures by using individual codes instead of comprehensive codes, she has decided to bill Dr. Pearson's services under the Medicare number of Dr. Craig (another Central City physician) until Dr. Pearson's credentialing process has been completed, and habitually submits a claim more than once if she isn't sure whether or not it has already been submitted or not.
1. Meredith is violating the False Claims Act (FCA) by submitting claims under another provider's billing number. She is also not following correct coding guidelines when billing for procedures that should be consolidated based on correct coding guidelines. This is considered unbundling and is a common type of fraud. It might be consider just abuse but there is no proof of intent required to create a FCA violation. 2. Yes, providers are responsible for the acts of the staff that perform services on their behalf.
Catholic Healthcare hired Ron to review the security policies and procedures related to employee selection and termination. Ron has been instructed to meet with the HIM director and determine where the HIM department may have additional requirements for its remote coding staff. Questions 1. For which of the administrative safeguards should Ron expect to see policies or procedures relating to the HIM department? 2. Which of the physical safeguards apply to the remote coders?
1. Most of the administrative safeguards discussed in the chapter apply. Have students refer to the chapter for the descriptions of these. There are nine administrative safeguard standards and six apply to this scenario including security management process, workforce security, information access management, security awareness training, security incident reporting, and contingency planning 2. All of the physical safeguards discussed in the chapter apply. Have student refer to the chapter for descriptions of these. There are four physical safeguard standards and they each apply to this scenario including facility access controls, workstation use, workstation security and device and media controls.
Omar has recently been hired as the HIM Director at a large medical center. He realizes that he has a number of employees whose job duties would allow them to work from home. Because his boss has asked him for a space reduction proposal, he recognizes the need to implement a work-at-home program for his employees. Questions 1. What steps should Omar take in developing a security program for the employees who will work from home? 2. Develop a checklist of considerations, along with a list of resources that would facilitate his security program.
1. Omar should review organizational policies and procedures to determine whether or not these are adequate or require modifications for remote workers. Polices that need to be reviewed include password management; virus protection; workstation use and access; storing and saving ePHI; and data transmission security. He should review the HHS guidance on remote use of and access to ePHI that is available at http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/remoteuse.pdf. He should conduct a risk analysis and determine strategies to mitigate the identified risks. He should review policies and procedures for safeguards for ePHI and conduct security awareness training specific for the employees who will be working remotely. 2. A sample checklist to assist with HIPAA Security compliance program is included here. This should be combined with the resources mentioned in this and the previous essay question that students can form into a table for future reference. Policy and procedure review Training and security awareness Records and access management Incident response plan Contingency and emergency operations plan Hardware, software and transmission security Audit control Computerworld also published a list of the 42 questions that HHS might ask which was developed about the first HIPAA security audit at Piedmont Hospital in Atlanta. http://www.computerworld.com/s/article/9025253/HIPAA_audit_The_42_questions_HHS_might_ask. This can we utilized for students to develop a checklist. AHIMA has a Practice Brief titled "Safeguards for Remote Access" that is available online and is a free resource. The information that follows is from that practice brief and provides additional policy and procedure guidance for remote access. Requiring specialized remote access user agreements delineating obligation to adhere to administrative, technical, and physical safeguards designed to protect the privacy and security of electronic PHI. Prohibiting taking work off-site. Work product that does not leave the premises is protected by whatever security features are installed on-site and in a well-functioning, controllable environment. However, emergencies must be handled by on-site staff or await reinforcements. Unplanned events ranging from an employee's minor illness to a disaster of major proportions can bring part or all of an operation to a grinding halt. Restricting off-site work to a controlled virtual network. Granting permission to work off-site at the organization's request and need only. With such a policy the organization owns the hardware and bears the responsibility to support such safeguards as password and content management protections, antivirus software, and spyware detection. It saves the cost of on-site office space, while enabling secure, controlled access from home. The downside is the cost of servicing both the hardware and software and the inability to monitor unsupervised work. Such permission should be restricted to self-motivated and independent workers and work types that can be objectively monitored both for quality and output. Requiring anyone who takes work off-site on his or her own initiative to assume responsibility for its security and maintain virus protection, patch updates, dispose of confidential waste, and log out. If remote access is for user convenience, strict policies must be developed and enforced including requiring adequate security in the off-site environment. NIST also has guidance for implementing the HIPAA Security Rule which might be helpful for students to review. It is available on line at http://csrc.nist.gov/publications/nistpubs/800-66-Rev1/SP-800-66-Revision1.pdf
Linda is the HIM director at Mercy Hospital. She is served with a subpoena duces tecum, directing her to appear at the law offices of John Jansen, Attorney at Law, for a deposition that will take place in two weeks. Mr. Jansen's office is 100 miles from Mercy Hospital. Linda appears at Mr. Jansen's office at the appointed date and time. She was recently relieved to learn that Mercy Hospital is not a party to the lawsuit. The parents of a 15-year-old boy are suing the local school district because their son fell out of an apple tree while involved in a school-sponsored activity, and he was subsequently treated at Mercy Hospital. Questions: Must Linda respond to the subpoena? Must Linda attend the deposition?
1. Yes, Linda must respond or risk being found in contempt of court or compelled to attend. Sometimes subpoenas are delivered without adequate advance notice, making it impossible to comply. A response is still required, however. If it is not possible to attend the deposition at the appointed time, Linda must at least contact the issuing attorney, inform him of this, and make alternative arrangements if possible. 2.Linda may request to submit certified copies of the records in lieu of attending the deposition. The attorney issuing the subpoena duces tecum must permit this, however. If the attorney does not permit copies to be submitted, he may agree for another person to attend in Linda's place. However, that person must hold a position in the organization that enables him/her to authenticate the record.
A newspaper reporter has requested a copy of the health records of Medicaid mothers and babies born in the last month citing the fact that the hospital is a state academic medical center, supported by state funds thus, subject to the state's public records or freedom of information laws. Discuss what is meant by such a law, what exemptions might be part of the law and whether the reporter should be allowed access to the records he is requesting.
All 50 states and the District of Columbia have public record laws that provide public disclosure upon request of any information from any public body in a state except as otherwise exempted by state regulations. At the federal level the Freedom of Information Act (FOIA) includes electronic information, codifies what information is subject to public disclosure, including whether the information is in paper or electronic form. The FOIA specifically provides for public disclosure upon request of many types of information in the possession of federal agencies, except those files that would constitute a clear, unwarranted invasion of personal privacy Exemptions that are usually pertain to the medical history, diagnosis, prognosis, or medical condition of a patient that is generated and maintained in the process of medical treatment. Also, records of hospital quality assurance committees and hospital boards or committees reviewing professional qualifications of present or prospective members of the hospital medical staff are exempt from mandatory disclosure. Other exempts may include issues related to adoption, abortion, law enforcement, and more. The reporter cannot have access to the health records of Medicaid mothers since the actual health record falls under the protection of medical history, diagnosis, prognosis, or medical condition of a patient that is generated and maintained in the process of medical treatment.
Background: The director of health information management, as the custodian of medical records, is having a great deal of difficulty responding to subpoenas for patient records. The facility is in the midst of converting from a paper-based to an electronic patient record. Some information is on paper (e.g., consents), some information is scanned immediately following discharge (e.g., nurses' notes), some information is automatically (COLD) fed into the EHR system (e.g., transcription reports) and some information resides within electronic systems (e.g., lab results and physician orders). The process of finding and identifying the various parts of the patient's record from the various sources is time-consuming and there is concern about insuring the same response (i.e. that the legal health record is produced) each time a record is requested. An attorney requested a record, followed by an additional request. What he received from the organization the first time was substantially different from what he received the second time. When the attorney deposed the custodian, many questions were raised about how record requests were handled, daily operational processes including how the patient's legal health record was compiled in response to this subpoena, and if this was the true and complete record for the patient.
First, the director needs to know all the sources of information (i.e., where all parts of the record reside). This can be challenging when some of the information resides in multiple electronic systems. S/he must be aware of all systems in the facility (for example, laboratory, pharmacy and radiology). These sources must be documented. Second, the director (with input from a team) must determine exactly which documents are part of the legal health record. This must be well thought-out and documented as well. Third, the director must train staff about all the sources of information (as described in the first paragraph) and what constitutes the legal health record (as described in the second paragraph). Although staff should be cross-trained, those who respond to subpoenas and other requests must be consistent so that they know the component of the legal health record well, know where to find them, and therefore respond to requesters consistently.
You are on the Charge master committee at Pike's Peak Clinic. An annual review of services and charges is being conducted for necessary revisions. Table 3-10 shows some statistics reported on the physicians' services at Pike's Peak Clinic last Tuesday. It takes twice as long to perform Service C, so the physicians are proposing that Service C should count as 2 services for the purpose of calculating workload. If Service C counts twice as much as Service A or Service B, which physician provided the most services on Tuesday?
It takes twice as long to perform Service C, so the physicians are proposing that Service C should count as 2 services for the purpose of calculating workload. If Service C counts twice as much as Service A or Service B, which physician provided the most services on Tuesday? Performance measurement involves the management functions of planning and controlling for adequate resources. A work measurement study can be performed to determine the time required to perform each of the services in establishing fees, with Service C counting as 2 units of service. However, the work measurement study should be repeated at a later time, because good management requires more than 1 study to base decisions on. Various factors could impact an individual's performance on a particular day, so to eliminate any variances in results obtained in the study it should be repeated. Calculation with each Service C counting as 2 units of service: -Dr. Truba's services provided calculates: 10 + 18 + (14 × 2) = 28 + 28 = 56. -Dr. Wooley's services provided calculates: 14 + 22 + (9 × 2) = 36 + 18 = 54. -Dr. Howe's services provided calculates: 18 + 5 + (6 × 2) = 23 + 12 = 35. -Dr. Masters's services provided calculates: 12 + 20 + (7 × 2) = 32 + 14 = 46. These calculations determine that Dr. Truba provided the most services on Tuesday.
Explain the principle of Good Samaritan laws. Discuss one way that you believe such laws are beneficial to society and one way that you believe they are detrimental to society.
Most states have some form of a "Good Samaritan" statute that protects various types of healthcare providers from liability for failing to obtain informed consent before rendering care to adults or minors at the scene of an emergency or accident. The rationale for Good Samaritan laws is that they are necessary to ensure that providers are not deterred from rendering aid at accident scenes for fear of being sued for battery or negligence. (Note that some states extend Good Samaritan laws to all individual who render aid.) Responses will vary by individual, but beneficial aspects include those just discussed above: that individuals will not hesitate to aid because of the fear of liability. Detrimental aspects may include assistance by individuals who should defer to other bystanders or passers-by who may be better qualified (in other words, is it wise to encourage amateurs to provide emergency medical care?).
Discuss the following situations. Charlotte Prince, HIM Director at a small community hospital, has been given the responsibility for providing any accountings of disclosures requested by patients under the HIPAA Privacy Regulations, including information on required reporting. She first has to determine what items are required reporting under the laws and regulations of her state. She finds that the following items must be reported and determines what departments in her hospital are responsible for the reporting them as shown in the table below. Item to be Reported Responsible Hospital Department Births, fetal deaths Labor and Delivery Deaths HIM Department Child or Elder Abuse Social Services Notifiable Diseases Infectious Disease Statewide Cancer Registry Cancer Registry Trauma Trauma Registry Medical Examiners Cases Risk Management Because these cases must be included in an accounting of disclosures under HIPAA, list two alternatives for meeting this requirement.
The Privacy Rule requires the tracking of disclosures of PHI, as discussed in detail in chapter 9. The accounting requirement includes disclosures that are made in writing, electronically, by telephone, or orally. HIPAA requires that instances of reporting required by law or regulation must be included in an accounting of disclosures. It is important that healthcare organizations and providers track disclosures in a central tracking system that enables departments or areas responsible for disclosing information under mandatory reporting laws to record disclosures. A healthcare organization or provider should make a list of these departments and the types of required disclosures made by each department so that when a patient requests an accounting of disclosures, the list can be referenced for items to be included in the accounting. The other option would be the creation of a central database that all of the identified departments could enter this information into the database when disclosures are made that require reporting.
Shelly is a new HIM graduate. She has been offered a position as an EHR trainer with a reputable EHR vendor, AutoDoc, which provides an EHR product to physician-office practices. As a condition of her employment with AutoDoc, Shelly is being asked to sign a noncompete agreement. She is concerned that she will be limiting a considerable number of future career opportunities if she signs the agreement and later leaves her employment with AutoDoc. Questions: 1. What types of limits are likely being placed on Shelly if she signs the non-compete agreement? 2. If AutoDoc's non-compete agreement was legally challenged, what would a court consider in determining whether it is enforceable or not?
The agreement likely includes restrictions on the amount of time that Shelly cannot compete with AutoDoc post-employment. It may also include restrictions on a particular geographic region (in which she would be prohibited from working/competing) and types of work. 2. A court would consider if AutoDoc had a valid business interest that it needed to protect (such as keeping Shelly from using the knowledge, information and skills she gained during her employment with AutoDoc against AutoDoc). It would also consider whether AutoDoc's non-compete agreement was unnecessarily broad (and whether it went beyond the company's valid business interest). A non-compete agreement is a contract, so it must be an agreement that includes an offer, acceptance, and consideration.
